Histrionic personality disorder

Written by Kate Norris
Kate Norris
Counselling Directory Content Team

Last updated 7th March 2024 | Next update due 7th March 2027

Histrionic personality disorder is a mental health condition that is primarily characterised by unstable emotions, attention-seeking behaviour and a distorted self-image where self-esteem may depend on the approval of others, rather than stemming from any true sense of self-worth. 

On this page, we explore the signs and causes of histrionic personality disorder, and how treatments like counselling can help.

We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another. 

The terms used on Counselling Directory are those that are generally used in the UK at the time. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.

What is histrionic personality disorder?

Histrionic personality disorder (HPD) falls within the Cluster B category of personality disorders, which also includes antisocial personality disorder, borderline personality disorder and narcissistic personality disorder. Cluster B personality disorders are characterised by dramatic or erratic behaviour. For people with histrionic personality disorder, this may present as constant attention-seeking and discomfort from not being the centre of attention.

Someone with HPD may often interrupt others to dominate the conversation, and may sometimes be referred to as a ‘drama queen’ due to their theatrical performances and gestures. Those with the disorder may dress provocatively to gain attention or may be sexually seductive in inappropriate situations.

Signs of histrionic personality disorder

Often seen as having good social skills, those with histrionic personality disorder may use these skills to manipulate those around them to make themselves the centre of attention. Other signs and symptoms of HPD can include:

  • exaggerated or rapidly shifting emotions
  • constantly seeking reassurance and approval
  • extreme sensitivity to disapproval and criticism
  • excessive dramatics, such as exaggerated emotions and expressions that appear to lack sincerity
  • self-centredness, often accompanied by a lack of concern for others 
  • inappropriate behaviour
  • low tolerance for frustration, easily bored by routines, or trouble finishing a project they have started 
  • extreme concern over physical appearance
  • difficulty maintaining relationships, or a tendency to believe relationships are more intimate than they are

As with many personality disorders, there is controversy and debate around how they are diagnosed, as well as the terms used to describe them. Those who are diagnosed with a personality disorder will often have symptoms of other disorders and may have multiple diagnoses.

What causes histrionic personality disorder?

The main cause of histrionic personality disorder is still unknown. Various factors are thought to contribute to the disorder, while many believe a mixture of nature vs nurture may have an impact. 

Histrionic personality disorder tends to run in families, however, expert opinion is divided on if this is a genetic factor or a learned behaviour children pick up from repeating behaviour they have seen from family members. Other factors that may have an impact are thought to include a lack of criticism or punishment as a child, positive reinforcement that is only given for certain behaviours, and unpredictable attention from parents.

Some people with histrionic personality disorder find that symptoms improve as they age, gain more life experience, and develop a better understanding of how to manage their responses and interactions with those around them. 

What treatment is available?

Individuals with histrionic personality disorder often seek treatment for depression following relationship breakdowns. Treatment for HPD typically involves psychotherapy, although medication may be recommended for short periods of time. Antidepressants or antianxiety medication may be prescribed if depression or anxiety is present alongside HPD symptoms.

The type of treatment you receive may vary based on the severity of your condition and the resources available in your local area. Typically, psychological therapies such as cognitive behavioural therapy (CBT) or psychotherapy are recommended, which can last for six months or longer. 

Working with a professional, qualified counsellor can help you to work through any areas that may be causing you distress or concern. Counselling can help you regulate your thoughts and emotions providing a safe space to speak without fear of judgement.  

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